Skill Checklists

RN APPEALS WRITER

This checklist was electronically signed on (Today’s date)

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

  • 1 = No Experience

  • 2 = Need Training

  • 3 = Able to perform with supervision

  • 4 = Able to perform independently

KNOWLEDGE, SKILLS, ABILITIES

Review, analysis and extraction of clinical information from patient records

Drafting of effective narratives for Medicare and Medicaid appeals documentation

Drafted briefs in support of denied cases under appeal at all levels of the government appeals process

Maintained current knowledge base of medical coding

Knowledge of federal and state hopsital Utilization Review ("UR") regulations

Knowledge of of Medicare guidelines regarding medical necessity

Knowledge of of Medicare guidelines regarding inpatient and outpatient observation

Research and preparation for beneficiary hearings

Experience testifying as expert witness in hearings

Collaborated with internal and external legal sources

Chart review skills

Ability to quickly research and extract relevant data from a medical record

Develop and Draft clear narratives for a solid case in support of medical claims for appeals

Experience with electronic medical record

Knowledge and experience with acute hospital utilization review using InterQual and/or Milliman

Working knowledge of medical coding

Knowledge and experience with case management

Knowledge and experience with government and contacted payers

Attention to details, timeliness and accuracy

Ability to work independently while working efficiently

Ability to work comfortably within a high production team

Age Specific Competencies

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.